AccountId: 011433970860
ContactId: 97c222e2-152a-4630-92ed-5d59ff6a040f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268019 ms
Total Talk Time (AGENT): 143546 ms
Total Talk Time (CUSTOMER): 89468 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/97c222e2-152a-4630-92ed-5d59ff6a040f_20250214T16:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm a provider. I'm calling to check benefits for a patient. They said that this is a secondary um insurance offered by her primary for her job or something like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sure, yeah, I can check benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] OK, thank you, and then can I get uh the policy number please?
[CUSTOMER][NEUTRAL] Yes, it's going to be um first can I give you my NPI or something where you can let us know if we are in network with y'all before we.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this, especially if it's our secondary, um, it's not a part of a network. Our secondary medical, um, it's very dependent on whoever they do have as their major medical as long as they're willing to pay that policy can if their major medical does not, then this policy simply can't.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, the policy number is gonna be 1514682.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] [PII], uh, date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy actually terminated [PII]. If you'll give me one moment, I'll see if she has one that's active, might just be a different policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, she does have one that is active. uh, let me know uh when you're ready I can give you this updated policy number.
[CUSTOMER][POSITIVE] Uh, I'm ready.
[AGENT][NEUTRAL] OK, it is 01868816.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one's effective date was [PII], um, and as it is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance again as long as major medical pays, um, were we looking at the outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am. She said it's a supplemental plan. I just need to know what plan is it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, yeah, um, so the outpatient benefit, let's see, of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, it is, um, $2550 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK, I'm sorry, you said um this is the deductible or out of pocket.
[AGENT][NEUTRAL] No, no, that's the benefit amount, that's the, that's the benefit amount that this policy would pay.
[AGENT][NEUTRAL] Until it per calendar year, so this policy doesn't have a deductible or any out of pocket.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, um, so is it a supplemental plan?
[AGENT][NEUTRAL] Yes, uh, so secondary medical is actually what it is, but it is more supplemental.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, can I get the plan, like is it a plan F, plan N, plan G?
[AGENT][NEUTRAL] It's just goes completely off of major medical. So again, as long as they're willing to pay, this plan is designed to help with co-pay, deductible and co-insurance until that calendar year amount is exhausted.
[CUSTOMER][NEUTRAL] Oh, OK. I, I've just never heard of a policy like this. Um, give me one moment, I'm trying to take notes as you, so it don't be confusing to other people when they.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um, so you said this is a calendar year, but it's no out of pocket, no deductible, it's just for the, you said it's 2500?
[AGENT][NEUTRAL] Uh, 2550, yes, 2550.
[CUSTOMER][NEUTRAL] OK. Um, and just to confirm, the group number is 16,350?
[AGENT][NEUTRAL] Oh, let me confirm that.
[AGENT][NEUTRAL] 16,350 yes.
[CUSTOMER][NEUTRAL] OK, can I get a reference number for this call, your name and last initial?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So the reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last [PII], was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, ma'am. Thank you so much for your time. Have a blessed weekend. Bye bye.
[AGENT][POSITIVE] All right. You too.